Poovillam S Subramaniam-Moothathu, MD, FAAN, FAHA, CIME

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

0101041206 Issued in VA

Practice address

3400 Boulevard
Colonial Heights, VA 23834-1418

Phone

(804) 741-6484

NPI assigned

May 27, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Petersburg Clinic Company LLC

  • Family Medicine Physician
  • Petersburg, VA
  • NPI 1881643617
  NPD (past)
• Spotsylvania Multi-Specialty Group, LLC

  • Internal Medicine Physician
  • Fredericksburg, VA
  • NPI 1588980015
  NPD (past)
• Neuromonitoring Services of America, Inc

  • Neurology Physician
  • Colorado Springs, CO
  • NPI 1134307531
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312934400000",
    "number": "1013910652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 WALSING DR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232298133",
            "telephone_number": "804-741-6484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 BOULEVARD",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238341418",
            "telephone_number": "804-741-6484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUBRAMANIAM-MOOTHATHU",
        "first_name": "POOVILLAM",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD, FAAN, FAHA, CIME",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2011-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "VA",
            "license": "0101041206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Alan Stansfield, D.D.S.
• Star Taxi Transportation
• Step N Up Youth Services, LLC
• Teresa Hawkins Stillion, M.D.
• Leland Stillman, MD
• Summit Health Care, Inc.
• Supportive Care of Virginia LLC
• Swift Creek Counseling, LLC
• Justin W Taggart, DPT
• Sunita Talegaonkar, M.D.

• Neurology Physician in Colonial Heights, VA
• Providers in Colonial Heights, VA by specialty
• Neurology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.